Provider Demographics
NPI:1831134915
Name:ORTHOPAEDIC CLINIC OF SALINA
Entity Type:Organization
Organization Name:ORTHOPAEDIC CLINIC OF SALINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KALLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-823-2215
Mailing Address - Street 1:523 S SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4145
Mailing Address - Country:US
Mailing Address - Phone:785-823-2215
Mailing Address - Fax:785-823-7459
Practice Address - Street 1:523 S SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4145
Practice Address - Country:US
Practice Address - Phone:785-823-2215
Practice Address - Fax:785-823-7459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100088560AMedicaid
KS004281Medicare ID - Type Unspecified
KS7408470001Medicare NSC